Distribution and prognostic value of high-sensitive troponin T measurement in patients with type 2 diabetes without cardiovascular disease.

AIM: The objective of this work was to define a value for the 99th percentile of high-sensitive troponin T and to evaluate the prognostic value of this biomarker in a population of patients with type 2 diabetes without a history of cardiovascular disease. METHODS: In this prospective, observational and analytic study, 482 patients with type 2 diabetes were enrolled. The patients were asymptomatic, with no history of cardiovascular events, renal insufficiency, or inflammatory or systemic disease. As events we considered a combined end point of major adverse cardiovascular events (MACE). RESULTS: 94.9% of the patients had detectable troponin values, 20.7% of the patients had troponin values above the healthy population reference upper threshold (14pg/mL). The 99th percentile value for this patient population was 48pg/mL. Age, sex, the glomerular filtration rate and hypertension were associated with troponin values>14pg/mL. The incidence of MACE was 3.96 per 100 patients/year (p/y) between those with hs-TnT>14pg/mL and 1.07 per 100 p/y between those with hs-TnT≤14pg/mL (HR=3.78 CI95 1.49-9.58; p=0.005). CONCLUSIONS: The 99th percentile value of troponin T in a population of patients with type 2 diabetes is 3-fold higher than the value proposed by the manufacturer for a healthy population. We also observed a significant difference in the distribution of troponin T values between men and women. This biomarker may be a valuable prognostic factor, since troponin T values above the reference upper threshold were associated with an increase in the risk of cardiovascular events in these patients.

Distribution and prognostic value of high-sensitive troponin T measurement in patients with type 2 diabetes without cardiovascular disease.

AIM: The objective of this work was to define a value for the 99th percentile of high-sensitive troponin T and to evaluate the prognostic value of this biomarker in a population of patients with type 2 diabetes without a history of cardiovascular disease. METHODS: In this prospective, observational and analytic study, 482 patients with type 2 diabetes were enrolled. The patients were asymptomatic, with no history of cardiovascular events, renal insufficiency, or inflammatory or systemic disease. As events we considered a combined end point of major adverse cardiovascular events (MACE). RESULTS: 94.9% of the patients had detectable troponin values, 20.7% of the patients had troponin values above the healthy population reference upper threshold (14pg/mL). The 99th percentile value for this patient population was 48pg/mL. Age, sex, the glomerular filtration rate and hypertension were associated with troponin values>14pg/mL. The incidence of MACE was 3.96 per 100 patients/year (p/y) between those with hs-TnT>14pg/mL and 1.07 per 100 p/y between those with hs-TnT≤14pg/mL (HR=3.78 CI95 1.49-9.58; p=0.005). CONCLUSIONS: The 99th percentile value of troponin T in a population of patients with type 2 diabetes is 3-fold higher than the value proposed by the manufacturer for a healthy population. We also observed a significant difference in the distribution of troponin T values between men and women. This biomarker may be a valuable prognostic factor, since troponin T values above the reference upper threshold were associated with an increase in the risk of cardiovascular events in these patients.

Desafíos de la jefatura de residentes: dificultades y logros del desempeño del rol en un hospital universitario de comunidad / Challenges faced by chief residents: difficulties and achievements of this role in a community teaching hospital

Introducción. El jefe de residentes es una figura estratégica en el liderazgo y cohesión entre los residentes.Objetivo. Caracterizar actividades desarrolladas por jefes de residentes e identificar logros y dificultades.Métodos. Se realizó una encuesta; sobre variables demográficas, actividades desarrolladas, situaciones más y menos gratificantes, necesidad de capacitación.Resultados. Contestaron el 88 % de los jefes de residentes; el 46 % fueron mujeres. Las actividades fueron asistenciales (el 26 %), gestión académica (el 25 %), docentes (el 24 %), administrativas (el 16 %) e investigación (el 10 %).La situación más gratificante fue el desarrollo del rol docente, y la menos gratificante, las dificultades en el manejo de relaciones interpersonales. El 57 % reconoció la falta de capacitación, y el 95 % recomendaría realizar la jefatura de residentes.Conclusión. La situación más gratificante fue el desarrollo del rol docente, y la menos gratificante, las dificultades en el manejo de relaciones interpersonales

Introduction. The chief resident plays a strategic role in terms of leadership and cohesion among residents.Objective. To characterize the activities developed by chief residents and identify their achievements and difficulties.Methods. A survey about demographic outcome measures, activities performed, most and least gratifying situations, and training needs was completed.Results. In total, 88 % of chief residents completed the survey; 46 % were females. Activities were related to health care (26 %), academic management (25 %), teaching (24 %), administration (16 %), and research (10 %). The most gratifying situation was playing a teaching role, and the least gratifying one were difficulties in the management of interpersonal relations. A lack of training was recognized by 57 %, whereas 95 % would recommend becoming a chief resident.Conclusion. The most gratifying situation was playing a teaching role, and the least gratifying one were difficulties in the management of interpersonal relations

Challenges faced by chief residents: difficulties and achievements of this role in a community teaching hospital. / Desafíos de la jefatura de residentes: dificultades y logros del desempeño del rol en un hospital universitario de comunidad.

INTRODUCTION: The chief resident plays a strategic role in terms of leadership and cohesion among residents. OBJECTIVE: To characterize the activities developed by chief residents and identify their achievements and difficulties. METHODS: A survey about demographic outcome measures, activities performed, most and least gratifying situations, and training needs was completed. RESULTS: In total, 88 % of chief residents completed the survey; 46 % were females. Activities were related to health care (26 %), academic management (25 %), teaching (24 %), administration (16 %), and research (10 %). The most gratifying situation was playing a teaching role, and the least gratifying one were difficulties in the management of interpersonal relations. A lack of training was recognized by 57 %, whereas 95 % would recommend becoming a chief resident. CONCLUSION: The most gratifying situation was playing a teaching role, and the least gratifying one were difficulties in the management of interpersonal relations.

Introducción. El jefe de residentes es una figura estratégica en el liderazgo y cohesión entre los residentes. Objetivo. Caracterizar actividades desarrolladas por jefes de residentes e identificar logros y dificultades. Métodos. Se realizó una encuesta; sobre variables demográficas, actividades desarrolladas, situaciones más y menos gratificantes, necesidad de capacitación. Resultados. Contestaron el 88 % de los jefes de residentes; el 46 % fueron mujeres. Las actividades fueron asistenciales (el 26 %), gestión académica (el 25 %), docentes (el 24 %), administrativas (el 16 %) e investigación (el 10 %). La situación más gratificante fue el desarrollo del rol docente, y la menos gratificante, las dificultades en el manejo de relaciones interpersonales. El 57 % reconoció la falta de capacitación, y el 95 % recomendaría realizar la jefatura de residentes. Conclusión. La situación más gratificante fue el desarrollo del rol docente, y la menos gratificante, las dificultades en el manejo de relaciones interpersonales.